“How can any health professional help anyone without this?!”


Being introduced to Clinical PNI (cPNI) is one of those rare paradigm-shifting experiences which I knew, even at the beginning, would change the way I think about clinical practice for good.  It was almost by chance that I went along to a two-day introductory seminar that was being discussed by colleagues at the Institute where I work.  We were being encouraged to go by our CEO, who knows a fair bit about PNI already and wanted to find out more about its new clinical application.  I had read a book on PNI by Robert Ader (one of its originators) some years ago so perhaps it was more curiosity that got me there in the end.  And, as a Nutritional Therapist, I have always felt there was more to the ‘Therapy’ aspect of what we could do for our patients than is commonly taught.

 

From the introductory seminar I realised that “y’know, there really may be something in this”!  But it didn’t take long for me to understand its real potential.  If I could tell you everything right here that I learnt during the first four days of the course I think you would be very interested indeed!  It was early on in my study of cPNI that I exclaimed to our first lecturer “how can any health professional hope to help anyone without this?!”.  It was a moment of both revelation and frustration.  Frustration that I had not been able to use these tools we were learning until now.  But as the opening days of the course unfolded my current knowledge was at once challenged and expanded.

What is Clinical PNI?

Putting it simply, Clinical PNI is the clinical adoption of the sciences concerned with the web-like interactions of the mind (psyche), nervous, immune, and endocrine systems.  But really that description would do it an injustice because it is so much more than that.  It is the doorway to a path into a world which has always been here, yet has now been signposted.  It is knowing how to truly combine hard facts with soft skills.  Clinical PNI honours Theodosius Dobzhansky’s comment that “nothing in biology makes sense without evolution” and later Frits Muskiet’s quote that “nothing in medicine makes sense without biology”, so that the health sciences are fundamentally unable to exist without the theory of evolution.  cPNI is well grounded in evolutionary biology.  But how do you use these in clinical practice?  Clinical PNI uses knowledge about physiological and biochemical mechanisms of action, epidemiology, in vivo evidence and human studies into workable clinical models.

 

I learnt that one of the key aspects of cPNI in practice is the understanding of physiological pathways, and only once you know the pathway can you ever expect to be able to modulate it, from origin (e.g. in the brain, so stressful thoughts that the patient has) to outcome (i.e. how the condition presents).  Naturally this will always involve the nervous system, but the NS is the carrier and processor of external stimuli.  So the senses are considered.  But just the five common ‘exteroceptive’ senses?  Clinical PNI recognises what is now being understood in biology that we also have ‘interoceptive’ senses: the immune system being one of them.  The immune system senses everything that is happening not only to the body, but the mind as well.  So mental alertness to danger or psychological stress ALWAYS activates the immune system and everything affects the immune system: psychological, neurological, endocrinological, sociological, epigentic and genetic factors transmit information through immune system activity, and people become ill when they suffer a hyper- of hypo-activity of the immune system.  In fact, chronic activation of one or more exteroceptive senses will cause low grade inflammation and disease.  So a chronic boring noise, such as the sound of the car or train on the journey to work, can cause illness and even cardiovascular pathologies.

 

Evolutionary genetics was a fascinating part of the course so far.  I gave a lecture to undergraduates on nutritional epigenetics last weekend and even managed to incorporate some of the detail I learnt on the cPNI course.  It was good to see how helping the students understand the evolutionary significance of the topic clearly helped them ‘get it’ a lot easier than otherwise.  And I could see how this would also benefit my patients.

How Clinical PNI can add to your practice

Leo, and cPNI, were offering the answer to what had been a silent frustration in my clinical practice: that there had not been a clear connection marrying what I had learnt about physiology, and nutrition etc, and the deeper issues relating to my patient’s psyche.

 

Sure, we have learnt about, and practice in our clinics, the many aspects of interpersonal communication between patient and health professional – the ‘listening beyond words’, i.e. ‘listening’ to the feelings and emotions that are being expressed beyond the spoken words, the non-verbal cues: eye contact, body posture etc., and they are important in cPNI.  But do I really know what is going on inside my patient?  Sure, I know that when they are telling me about a stressful experience which influences their food choices then their stress hormones are elevated, and other biochemical changes are occurring.  But, as a practitioner, do I really know why that’s happening and, most importantly, what to do about it?  I believe this post-graduate education in cPNI will become an essential clinical component for all health professionals.  Why?  Let’s take my role as a Nutritional Therapist for example.  Traditionally the focus has been more on the biochemical and physiological aspects of nutrition, but it is clear that physiological biochemistry provides only partial answers to the problems in achieving health. 

There are two old adages that are increasingly supported by scientific research which states:

 

  • “you are what you eat” – i.e. the molecules that comprise your food become the molecules that comprise your body, and also
  • “you eat what you are” – our phenotype is determined by the choices (which stem from our life experiences etc) of what an individual puts into their mouth.

So there are two focuses of the nutrition phenomena, one which occurs before the lips (BL) and one which occurs after the lips (AL).  Nutrition experts tended to focus on AL phenomena, yet as science progresses and our understanding of what are the determinants of health becomes clearer, we realise that to neglect either is a recipe for failure in helping someone achieve optimal health.  If we remain only interested in AL phenomena perhaps we would be better suited to becoming a mechanic or engineer, because there are also the beliefs and behaviours of the patient to address when working as a health professional.  It is all about addressing the deeper issues of homeostasis and allostasis - hunger, cold, anger, tiredness, and identifying what the body is really searching for to rebalance.  And this is where cPNI shines bright!  One of the most significant ‘aha!’ moments for me was realising that I will now not need to run a myriad of expensive lab tests on my patients, which they cannot afford anyway.  Because once we start to understand the homeostatic feelings at a deeper level – the brain’s neuroendocrinal reward/anger/fear systems, and what it is searching for then the therapist is in a profoundly stronger position to be able to intervene where necessary for the patient.  These are fundamental aspects of our physiology which have been clinically ignored until now and should always be the first route for intervention.  Don’t get me wrong – this isn’t psychotherapy!  It is incorporating methods that we can all use, whatever our discipline.

 

We practiced these techniques on our fourth day in the classroom.  And when I used them on my next patient to investigate and explain their condition from a cPNI point of view it almost bought me tears of joy when I saw the lights go on in their eyes.  It was quite wonderful and, from my clinical experience, I knew their recovery would be enhanced!

In the cPNI class, some of the clinical questions and issues we discussed were:

  • To focus on the main thing affecting or worrying the patient, but keep it neutral and let the patient interpret their own story from it.  This is more important than it may sound because physiologically it incorporates the PNI pathways.
  • Go back to the origin of the condition.
  • What would the patient do if they didn't have the condition? Do they know?
  • Are they trying to mask something that affected their psychological / social / sexual context?
  • Reframing is a key part of the therapy.  It is similar to NLP reframing, but not the same.  With reframing comes the concept of deep learning – our adaptogenic capacity.  How we are capable of adapting to new circumstances.

 

 

The standard of training from The Natura Foundation

Our lecturer for the first four days of which this blog entry covers was Associate Prof Leo Pruimboom.  Leo is the Scientific Director of the Natura Foundation and his natural charisma and profoundly deep knowledge means his lectures are comprehensive, fascinating, and entertaining.  Leo is one of those extraordinary scientists and educators whom you listen to and think “how do you remember all this stuff?!” or “how is it that you’re really interesting to listen to, yet must have spent every waking minute of your life with your eyes in a scientific journal (which are not known to be most conducive experiences to developing an interesting personality)?!”  I once heard a phrase to describe listening to Dr Jeffrey Bland’s lectures is ‘like drinking from a fire hydrant’ – the quality information delivery is relentless, But the water tastes great!  And I would say the same for Leo’s dynamic delivery.  I sincerely hope that one day you will get the opportunity to hear him speak and learn from him.  It was interesting that one of the first things he asked us was “how much of your brain do you think we use?”.  The clichés of ‘only 10%’ were offered in reply, but Leo confirmed that it is nearer 100%, and we could see that he clearly hasn’t wasted any of his brain space!  In fact one of the most memorable parts of the four days were Leo’s pathway mind-maps.  It perhaps doesn’t mean too much without Leo’s full explanation but this is a photo of the sort of thing we were learning.

 

My class is about 25 students.  We’re all graduates and I think we are all practitioners too.  It seems that most of us are involved in nutrition, not that this is of any significance to cPNI.  Clinical PNI is appropriate for everyone.  It is difficult to describe everything that was covered in our first four days.  They were very full-on and I have immersed myself in the published research and deepening my understanding since.  We have only been taught by Leo so far so I cannot comment on the quality of the other lecturers.  But I will!  In the meantime I urge you to read about cPNI on the Natura Foundation website…and watch this space.

 

Adam Thornton B.Sc. (Hons) mBANT is a qualified Nutritional Therapist.  He read for his first degree in Nutritional Therapy at the University of Westminster, studying the Functional Medicine model of healthcare. Adam is a lecturer and tutor at the Institute for Optimum Nutrition in Richmond, London.  He sees patients at clinics in Bedford and central London.

 

If you would like to contact Adam to ask for his impartial opinion about being a post-graduate student of Clinical PNI then please e-mail him at info@adamnt.com.